A typical definition for a leader is one who has the ability to influence. Florence Nightingale, Abraham Lincoln, and Martin Luther King readily come to mind for their ability to inspire others and create forces to change the world. A history of the nursing profession reveals countless nurses who have made significant contributions to patient care. These individuals were flexible, had a “can-do” attitude, saw the big picture, identified needed change, and motivated others to follow. These characteristics can also describe a nurse leading at the bedside.

Bedside nurses have significant influence, but often don’t see themselves as leaders. Yet they have a direct influence on nosocomial infections, falls, pressure ulcer development, pain management, quality improvement, and safety. They also influence length of stay, complications, mortality, patient satisfaction, and the resumption of the activities of daily living. By acting as leaders, bedside nurses can influence not only the outcomes of their patients but also the outcomes of the organization.

This goal of this article is to help bedside nurses understand that they are leaders and to focus personal development on enhancing or acquiring leadership skills. The good news is that gaining these skills doesn’t mean leaving the bedside.

Ready to lead?

Here are some questions to ask yourself when reflecting on your potential to lead.

• Do you think of yourself as a leader?
• Are you self-confident?
• Are you a risk taker? Taking risks doesn’t necessarily mean being a daredevil. You can practice risk taking with simple tasks, such as inviting friends over for dinner and fixing a dish you have never prepared.
• Are you able to work outside your comfort zone?
• Are you willing to accept a challenging care assignment?
• Do you have a positive attitude?
• Are you a people person?
• Do you see changes that are needed in the practice or work setting?
• Do you ask peers, “Why are we doing it this way?”
• Do your colleagues seek your opinion on care management problems?
• Are you a preceptor?
• Do you read the nursing literature?
• Are you on unit or hospital committees?

If you answered yes to several of these questions, consider yourself a burgeoning leader. Begin planning to develop and refine leadership skills to shape your career path. Here is a “to-do” list with specific strategies to incorporate as you increase your influence on patient outcomes.

• Every leader needs to understand his or her leadership characteristics and skills. Complete a social style inventory and leadership assessments to explore your potential. F.A. Davis offers the following assessment: http://davisplus.fadavis.com/grossman/interactive_exercises.cfm.
• Once you understand yourself better, explore available options for a mentored relationship. Mentoring is a key component in professional development. Be willing to ask the mentor “Am I leader material?”
• Investigate formal education options and pursue the one that is right for you.
• Read and bring evidence-based ideas to the unit. Be ready to show your peers how the evidence is applicable to your unit.
• Join a professional organization and become an active member. You can start small and work to your desired level of participation.
• Network to establish interprofessional relationships and build partnerships to strengthen healthcare processes.
• Listen to colleagues when they say something like, “You should apply for that job.” They see your leadership in action everyday.
• Challenge negative behaviors of others such as bullying, chronic tardiness, and negative attitudes.
• Be accountable to and an advocate for your peers.
• Accept new challenges, assignments, and positions with a positive attitude. Support others in this as well.
• Meet with superiors regularly for feedback on your job performance and participate in continuous self-evaluation.
• When you find a problem, provide a solution. Look for answers in multiple places; for example, the literature, other units, and other hospitals.
• Develop and mentor new nurses and support staff. People will recognize your sincere desire for others to become successful.
• Volunteer to promote change on the unit and organize a task force for a quality improvement project. This rewarding strategy demonstrates to others that a work process can be modified and care delivery improved. Identify a problem, discuss it with your supervisor, engage those personnel involved, and reshape the work environment. Quality improvement topics might include implementing hourly rounding, starting bedside reports, or eliminating redundancy in documentation.
• Start a journal club on the unit. You can take a formal approach, with guidelines, a template, and established meeting times with discussion questions. An informal tactic might be to identify a group of interested colleagues or a peer who is returning to school for a degree and then share articles during lunch.
• Strengthen your committee involvement by reviewing the agenda and pertinent policies before the meeting and contributing to the discussions during the meeting. This engagement is a perfect opportunity to role model professional behaviors.
• Ask for shadowing opportunities with leaders in healthcare and business. This valuable activity will broaden your knowledge base, forge connections, provide a deeper perspective of decision-making, and allow you to reflect on varying leader strategies used by others. If you shadowed the nurse manager in your emergency department or the postanesthesia care unit, a request to transfer patients can result in assistance and support instead of frustration. This opportunity is even better when the shadowing goes both ways!
• Lead in every direction, this includes your supervisor, peers, and subordinates. A practical application is leading a patient care team (nurse, care technician, unit clerk, patient, and family). Share the patient goals or vision for the day, seek input on implementation, and evaluate the plan; the result will be more effective performance.

This to-do list can be individualized and matched with personal strengths and weaknesses identified in the leadership inventory.

Stand up and lead

Don’t sell yourself short; recognize you are a leader at the bedside, a driver of patient outcomes, and a necessary resource for patients, families, and organizations. Capitalize on your strengths and gain control over your career journey. Leadership attributes are essential no matter where your career path takes you. You are a leader!

Nancy Duffy is chair and professor of the proposed department of nursing at Campbell University in Buies Creek, North Carolina, and Shannon Bright Smith is a nursing instructor at the Medical University of South Carolina College of Nursing in Charleston, South Carolina.

Selected references

Comack M. A journey of leadership: From bedside nurse to chief executive officer. Nurs Admin Q. 2012;36(1):29-34.

Grossman SC, Valiga TM. The New Leadership Challenge: Creating the Future of Nursing. 3rd ed. Philadelphia, Pa: FA Davis; 2009.

MacPhee M. Strategies and tools for managing change. J Nurs Adm. 2007;37(9):405-13.

Maxwell J. The 360° Leader. Nelson Publishing. 2011.

National quality forum: What we do. Available at: http://www.qualityforum.org/what_we_do.aspx. Accessed October 30, 2013.

Pate M. Nursing leadership from the bedside to the boardroom. AACN Adv Crit Care. 2013;24(2):186-193.

Porter-O’Grady T, Malloch K. Leadership in Nursing Practice. Burlington, MA: Jones & Bartlett Learning. 2013